Role of Scrub Nurse

Write about the Case Study for Placement at Operating Room.

I was placed for a week in emergency theatre as a part of 12 weeks programs. As I was a part of orthopaedic theatre, I had got to observe hip and knee replacements.  Registered nurse working as the scrub nurse assists in surgical procedures by setting room before operation.  Scrub nurse work with physician as well as the patient till moved to recovery room (Niu et al., 2017).   It is the duty of the circulating nurse to ensure that everyone works as team right from the preoperative to postoperative care. The nurse may pay strong attention to detail and act as patient advocate, reposition the patient and address the family concerns (Aholaakko & Metsälä, 2015).  I have selected the roles and responsibilities of scrub nurse and the circulating nurse when assigned to attend the hip surgery of Mrs. X 69 year old lady, who has suffered a major fall and injury.

According to competency- 4 of the perioperative registered nurses the scrub and circulating nurse are responsible for eliminating the potential danger to the patient.  They were accountable to maintain safe environment (Ammouri et al., 2015).  

As a scrub nurse I have used personal protective equipment, performed hand hygiene (effective hand hygiene), and adhered to the trust’s safe management and handling of specimens in operation room. It will protect from infections like HIV and others. Further, I have maintained the positive patient interaction by meeting the emotional and spiritual needs in operating room. The patient was positioned in the operation theatre to ensure ideal visualization and has no physiological compromise and better access to surgical site.  It was made sure that the positioning did not cause any harm to the patient’s skin and joints.   After safe transfer of patient the skin preparation was the next step. I have tested the skin integrity and have documented the same ((Kang et al., 2015).

Any drug related concerns in Mrs. X is addressed by circulating nurse before moving patient to operation theatre.  A complete head-to-toe assessment was conducted as a role of the circulatory nurse. It includes airway assessment followed by neurovascular and pain assessment for informing surgeon.  To reduce the patient’s anxiety I had discussed with the patient in presence of surgeon about the recovery and rehabilitation plans. It relieved the patient from anxiety and stress that caused due to outcomes of surgery. As Mrs X was anxious about the pain after surgery. I had assured her that on adhering to care practices and medication she would soon recover and resume independence soon.  I had explained her as to how the postoperative pain would be managed. To be effective in professional communication I had maintained positive body language and ensured that my words match the tone of voice while giving psychological support and when interacting with family members (Kang et al., 2015).

Role of Circulating Nurse

The scrub nurse is also responsible to maintain patient’s dignity. Mrs X’s consult was taken when assisting her for change of clothes and toileting before surgery. It was necessary as Mrs. X had strong concern for her modesty (Northcott & Wilson, 2016).  Addressing her concern maintained patient’s dignity. I had effectively communicated with the patient, her husband and elder daughter about the ongoing procedure. I had updated with every process being taken before surgery as it is there right to know.

When communicating with Mrs. and family it is the role of circulatory nurse is to maintain patient rights and dignity. I used polite tone as during initial interaction I have observed that the family believed in polite, relatively informal and being tolerant.  Mrs X is Buddhist and she was strict vegetarian. She initially refused medication as it would consider the animal protein. However, she later agreed when I explained about her critical care and importance of medication before surgery. Maintaining the religious beliefs and the cultural values during hospital stay greatly impacts the care process (Ku, 2016).

It is the role of the scrub nurse to maintain sterile environment in operating room before surgery. One of the primary duties in operation room is selecting and passing instrument (Ammouri et al., 2015). During the operation I have maintained sterility throughout the procedure. I remained adhered to the policy regarding the surgical needles. I have arranged all the instruments on the back table before surgery.  Instruments were passed to sturgeon in decisive and positive manner. From the sterile field, excess instrument were removed and the aseptic technique was followed as per the hospital policy.  I have ensured that all the medical equipment is intact by detailed examining. I have checked availability of the instruments sets.  I have ensured that the operation theatre was decontaminated and set up accordingly. I have tested the functioning of the overhead light, diathermy and suction machine. The equipments necessary for positioning the patient was kept ready. Upon consulting with other senior circulating and scrub nurse, I have restocked the supplies such as disposables, gowns, swabs, drapes, and others. In line with this the expiry date of the supplies were scrutinised.  After the entry of patient, the surgical site was also scrubbed with betadine.  These measures will help promote patient safety.

After the entry of surgeon, I had stayed away from operating table as a circulatory nurse to assist in case of need of additional instruments that needs to be arranged. After operation the wastes were segregated using appropriate colour coded receptacles while making sure the instrument count is correct along with other scrub nurses. Once again the whole area was decontaminated for nest surgery (competency 4; competency 1, ORNAC 2012; Wistrand et al., 2018).

Maintaining a Safe and Sterile Environment

The role of the scrub nurse is to keep the records of the surgical site status alongside collaboration with circulatory nurse before surgery. I cleaned the surgical site with betadine to prevent infection and ensure that after surgery, the site has no bleeding (Kang, Massey & Gillespie, 2015). 

As a role of circulatory nurse, the patient’s airway assessment is conducted so as to maintain the safety prior to administration of the anaesthesia.  The patient is assessed for drug or food allergy. I made it sure by confirming with the surgical team that all the vital checks are conducted. On discussion with the physician, I have instructed about the eating, drinking and medication to be taken before surgery.  The patient was treated with patient centered care and psychological support was given to reduce anxiety and stress before surgery (Kang, Massey & Gillespie, 2015).

In my role as scrub nurse I had implemented the knowledge of nursing, humanities and science. I had created a respectful environment for patient before and after surgery to reduce stress and anxiety which is in accordance with first standard of ORNAC.  I had adhered to the standard policies and precautions to prevent infection. To adhere to standard 5 of ORNAC I have coordinated the resource availability at the department level.  Throughout my placement I was ethical, open, honest and transparent in communication with professionals as well as patient (Standard 8 ORNAC) (ORNAC, 2012-).

As a circulatory nurse I had ensured effective clinical decision making by conducting regular patient assessment, discuss the concerns and address the same on coordination with physician as per the second standard of ORNAC. The patient data was collected in accordance with surgical goals. As per standard 3 of ORNAC, I was responsible for accurate documentation of patient’s health data (ORNAC, 2012). Therefore, I had practiced patient safety and promoted advocacy. I was engaged with surgical team and ensured adequacy of instruments. I had collaborated with anaesthesiologists prior to shit of patient for surgery.  In accordance with the standard 9 I had meet the preoperative health needs of the patient and family as well as surgical team (ORNAC, 2012; Niu et al., 2017).

 The role of the scrub nurse is to maintain the legal aspects of operating room.  On the patient’s arrival the use of surgical safety checklist as mentioned by the World Health Organisation as vital practice in the operation theatre. As a scrub ensure I had ensured that surgical site is scrubbed with solution like betadine to prevent infection. The safety of providing the anaesthetics is verified. I have personally verified the anaesthetic equipment, and  drugs related concerns (competency I- professional practice). I was instructed to collect specimen of Mrs X.  The role of the scrub nurse before doing so, is to confirm with the surgeon about the specimen type and the location to be sent such as microbiology and histology.  I had adequately labelled the container with the patient details along with date and type of specimen (ORNAC, 2012).

Effective Communication

The patient Mrs X would be identified by circulatory nurse with the anaesthetist along with the practioner in the operating department. I have confirmed with them about the surgical procedure and the surgical site. The confirmation is taken and the consent is checked. It will prevent operating on the wrong patient. Followed by this, the site to the surgery is marked (competencies of perioperative registered nurses; ORNAC, 2012). As a role of circulatory nurse, I removed the specimen by taking consent from the surgeon. As I was in direct exposure to blood, body fluids and secretions I had adhered to the standards of infection control in hospital and WHO’s five moments of hand hygiene. I had also ensured good record keeping, as it plays a significant role in legal and professional incidents. Therefore, I had made all the entries and documentation work legibly and accurately. After the surgery I had got the documentation checked by senior sub nurse (COMPETENCY 1 and 2: role of circulating and scrub nurse role, ORNAC, 2012).  

 As a scrub nurse I gave my best to cooperate with other nurses in the surgical team. I did communicate all the information of patient prior to the surgery effectively. I had collaborated with scrub team to learn the effective instrument count process before and after surgery. It was initially difficult for as I was not aware of many surgical instruments initially.  Further exposure to this area will make more efficient with surgical count process. Effective communication helped overcome chance of miscommunication. Excellent communication skills were implemented to assist surgeon with his needs in operation room (Oelke, Wilhelm & Jackson, 2016).  

I did not assume anything for my work as a circulatory nurse. I had implemented the WHO checklist to collaborate with my team mates.  My actions were based on information sharing with multidisciplinary team and shared decision making when undertaking the role of circulatory nurse.  I had discussed with surgeon before patient positioning. I had coordinated with the other theatre practioner (Oelke, Wilhelm & Jackson, 2016; Niu et al., 2017). It helped me in successful and safe transfer of Mrs. X.

Upon self evaluation I had realised gaining more confidence than previous experience of operation theatre. This placement has improved my knowledge, skills to act on professional manner.  The one area of improvement for me is the maintaining patient rights and dignity.  I need to develop my cultural awareness of different patients. as I was nervous when dealing Mrs X. Therefore, I could learn about interdisciplinary communication, problem solving and critical thinking with this placement, where I could under take both the role of scrub and circulatory nurse on alternate days.

References

Aholaakko, T. K., & Metsälä, E. (2015). Aseptic practice recommendations for circulating operating theatre nurses. British Journal of Nursing, 24(13), 670-678.

Ammouri, A. A., Tailakh, A. K., Muliira, J. K., Geethakrishnan, R., & Al Kindi, S. N. (2015). Patient safety culture among nurses. International nursing review, 62(1), 102-110.

Brodin, K., Hellzén, O., & Häggström, M. (2017). Intraoperative Care of the Conscious Patient from the Perspective of the Operating Theatre Nurse: A Grounded Theory. Open Journal of Nursing, 7(09), 1086.

Kang, E., Massey, D., & Gillespie, B. M. (2015). Factors that influence the non?technical skills performance of scrub nurses: a prospective study. Journal of advanced nursing, 71(12), 2846-2857.

Ku, Y. L. (2016). Spiritual needs and care of patients from nurses’ perspectives on ICU. J Nurs Care, 5(357), 2167-1168.

Niu, L., Li, H. Y., Tang, W., Gong, S., & Zhang, L. J. (2017). Evolving safety practices in the setting of modern complex operating room: role of nurses. Journal of biological regulators and homeostatic agents, 31(3), 659-665.

Northcott, H. C., & Wilson, D. M. (2016). Dying and death in Canada. University of Toronto Press.

Oelke, N., Wilhelm, A., & Jackson, K. (2016). Optimising the collaborative practice of nurses in primary care settings using a knowledge translation approach. Evidence & Policy: A Journal of Research, Debate and Practice, 12(4), 605-615.

ORNAC (2012). Standards, Guidelines and Position Statements for Perioperative Registered Nursing Practice. Retrieved from https://flex5114.weebly.com/uploads/1/4/5/1/14518934/ornac_standards.pdf

Robertson, S. (2016, May). Invisible without scrubs: What we don’t know about nursing leaders in Canada. In Healthcare management forum (Vol. 29, No. 3, pp. 104-106). Sage CA: Los Angeles, CA: SAGE Publications.

Wistrand, C., Falk-Brynhildsen, K., & Nilsson, U. (2018). National Survey of Operating Room Nurses’ Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections. Surgical infections.